脑后部可逆性脑病综合征的CT、MRI诊断  

Posterior reversible encephalopathy syndrome:diagnosis with CT and MRI

作　　者：王光彬[1] 单瑞芹[2] 赵斌[3] LeeC.Chiu 杨贞振[3] 史浩[3] 

机构地区：[1]山东省医学影像学研究所MR 室,济南250021 [2]济南市妇幼保健院产科 [3]山东省医学影像学研究所MR室,济南250021 [4]Department of Radiology,Saint Joseph Medical Center,Burbank,California,USA

出　　处：《中华放射学杂志》2006年第9期908-912,共5页Chinese Journal of Radiology

摘　　要：目的探讨 CT、MRI 在诊断脑后部可逆性脑病综合征(PRES)中的价值。方法 8例女性 PRES 患者中6例为孕妇,1例肺癌手术后化疗患者,1例高血压患者,均行 MR 静脉成像(MRV)、T_1WI、T_2WI、水抑制序列(FLAIR)成像及扩散加权成像(DWI);其中2例行 CT 平扫,5例行增强 MRI 及三维增强 MR 血管成像(3D CEMRA)。结果 CT 示病灶呈低密度,边界不清。8例患者MRV 显示脑静脉、静脉窦通畅,无狭窄、异常扩张及血栓形成征象。MRI 显示双侧顶枕叶(8例)、基底节区(2例)、额叶(4例)多发异常信号,主要位于双侧顶枕叶皮质下白质内,3例患者皮质亦受累。在 T_1WI 病灶呈等或略低信号,T_2WI 及 FLAIR 呈高信号,以 FLAIR 像显示皮质病变为佳。DWI 显示大部分病灶呈等信号,表观扩散系数(ADC)图呈等或高信号。部分病灶 DWI 及 ADC 图均表现为高信号。随访 MRI 显示所有患者病灶范围、数目逐渐变小、减少。5例行增强扫描患者显示病灶呈轻度强化,3D CEMRA 显示强化沿双侧大脑前动脉、大脑中动脉及大脑后动脉终末支分布,部分呈“葡萄状”。随访增强扫描显示病灶强化范围及程度逐渐缩小、消失。结论 FRES 好发于顶枕叶白质,但也可见于基底节、额叶及脑皮质。病变为血管源性水肿,增强 T_1 WI 及3D CEMRA 显示病灶有可逆性强化。以 MR FLAIR 及 T_2WI 序列显示病灶最佳。Objective To evaluate the role of CT and MRI in the diagnosis of posterior reversible encephalopathy syndrome （PRES）. Methods Eight women with PRES （6 pregnant women, 1 case after chemotherapy, and 1 patient with hypertension） were enrolled in our study. All of them had MR imaging （T1 WI, T2 WI, FLAIR, DWI） , and five cases underwent post-contrast T1WI and three dimensional contrast enhanced MR angiography （3D CEMRA）. Two cases also had CT scan. Results MRV in all 8 patients showed no evidence of stenosis, dilation, or thrombosis in cranial veins and sinuses. MRI demonstrated multiple lesions located in bilateral parieto-occipital lobes （8 cases） , bilateral basal ganglia （2 cases） , and bilateral frontal lobes （4 cases）. The lesions were prominent within white matter, some of them involved gray matter （3 cases ）. Lesions appeared as hyperintense signals on FLAIR and T2-weighted images, isointense or mildly hypointense signals on T1-weighted images, normal or decreased intensity on DWI, and isointensity or hyperintensity on apparent diffusion coefficient （ADC） maps. Post-contrast Tt WI showed mild reversible enhancement and 3D CEMRA displayed numerous reversible ＂ grape-like＂ enhancements in terminal arterial branches along the middle cerebral artery （MCA）, anterior cerebra/ artery （ACA） and posterior cerebral artery （PCA）. Follow-up scan showed decreased abnormal signals. Conclusion Lesions of PRES are usually located in parieto-occipital lobes, especially in white matter, but they can also be seen in frontal lobes and basal ganglia bilaterally. Post-contrast T1WI and 3D enhanced MRA can provide useful information in the manifestation of reversible enhancement. MRI has advantages to display lesion in PRES.

关 键 词：脑疾病 顶叶 枕叶 磁共振成像 体层摄影术 X线计算机 

分 类 号：R742[医药卫生—神经病学与精神病学] R445[医药卫生—临床医学]